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Maintenance immunosuppressive therapy in renal transplantation in adults

Authors
Karen Hardinger, PharmD, BCPS
Daniel C Brennan, MD, FACP
Section Editor
Barbara Murphy, MB, BAO, BCh, FRCPI
Deputy Editor
Albert Q Lam, MD

INTRODUCTION

Maintenance immunosuppressive therapy is administered to almost all renal transplant recipients to help prevent acute rejection and the loss of the renal allograft. Although an adequate level of immunosuppression is required to dampen the immune response to the allograft, the level of chronic immunosuppression is decreased over time (as the risk of acute rejection decreases) to help lower the overall risk of infection and malignancy; these risks directly correlate with the degree of overall immunosuppression.

The optimal maintenance immunosuppressive therapy in renal transplantation is not established. The major immunosuppressive agents that are available in various combination regimens are glucocorticoids (primarily oral prednisone), azathioprine, mycophenolate mofetil (MMF), enteric-coated mycophenolate sodium (MPA-EC), cyclosporine (in nonmodified or modified [microemulsion] form), tacrolimus, everolimus, rapamycin (sirolimus), and belatacept [1-3].

Conventional maintenance regimens consist of a combination of immunosuppressive agents that differ by mechanism of action. This strategy minimizes morbidity and mortality associated with each class of agent while maximizing overall effectiveness. Such regimens may vary by patient, transplant center, and geographic area.

The regimens and agents used for maintenance immunosuppression following renal transplantation will be reviewed in this topic. A discussion of induction therapy in renal transplantation is presented separately. (See "Induction immunosuppressive therapy in renal transplantation in adults".)

OVERVIEW OF OUR APPROACH TO INITIAL MAINTENANCE THERAPY

Transplanting an immunologically nonidentical kidney into a patient without administering immunosuppressive agents invariably results in allograft rejection and loss. Thus, maintenance immunosuppressive therapy is given to practically all recipients of renal allografts.

                                

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Literature review current through: Nov 2016. | This topic last updated: Tue Nov 29 00:00:00 GMT+00:00 2016.
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